Cool Springs Plastic Surgery Nashville | Breast Augmentation Franklin | Abdominoplasty Mt. Juliet
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Dr. Konrad Sarosiek
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Olivia Gibson
Amanda Davis
Teresa Safford
Chrissy Handly
Michele Bailey
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Jennifer Wolfe
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Destiny Berger
Savannah Brasells
Heather Happy
Elizabeth Bruhin
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Survey – Non-Surgical
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Survey – Non-Surgical
Survey – Non-Surgical
Step
1
of
6
16%
Please select the location of your most recent visit to our practice.*
(Required)
Franklin (Cool Springs)
Nashville (Music Row)
Mt. Juliet
Brentwood
Please select the practitioner you saw:*
(Required)
Heather Happy, Aesthetician
Savannah Brasells, Aesthetician
Emily Findley, RN
Teresa Safford, RN
Michele Bailey, RN
Olivia Gibson, RN
Susan Conner Vickers, RN
Olivia Salmen, RN
Eva Irvin, RN
Destiny Berger, Aesthetician
Elizabeth Bruhin, Aesthetician
Amanda Davis, NP-C
Chrissy Handly, RN
What was the key reason(s) you chose our practice for your procedure? (Choose all that apply)*
(Required)
Friend/Family Referral
CSPS Employee
Physician Referral
Website
Reputation/Experience
Information Provided to Me
Magazine or Newspaper Ad
Cost
Facility / Office
Location
Seminar
Location
Seminar
Google
Already a Patient
Seminar
Instagram
Facebook
YouTube
Other
What Other key reason(s) you chose our practice for your procedure? (Please fill the field below)*
(Required)
Receptionist & Waiting Room Experience
When you arrived at the office, how would you rate the RECEPTIONIST in the following areas: Friendly & Courteous?*
(Required)
Excellent
Very Good
Good
Average
Fair
Poor
Please Explain:
Helpful?*
(Required)
Excellent
Very Good
Good
Average
Fair
Poor
Please Explain:
How acceptable was the amount of time spent in the reception area and exam room, before being seen for your procedure?*
(Required)
Excellent
Very Good
Good
Average
Fair
Poor
Please Explain:
Comments
Staff Experience
During your consultation, how would you rate our staff in the following areas? Friendly & Courteous?*
(Required)
Excellent
Very Good
Good
Average
Fair
Poor
Please Explain:
Competent & Professional?*
(Required)
Excellent
Very Good
Good
Average
Fair
Poor
Please Explain:
Sympathetic & Caring?*
(Required)
Excellent
Very Good
Good
Average
Fair
Poor
Please Explain:
Comments
Practitioner Experience
During your examination, how would you rate the practitioner in the following areas? Friendly & Courteous?*
(Required)
Excellent
Very Good
Good
Average
Fair
Poor
Please Explain:
Competent & Professional?*
(Required)
Excellent
Very Good
Good
Average
Fair
Poor
Please Explain:
Sympathetic & Caring?*
(Required)
Excellent
Very Good
Good
Average
Fair
Poor
Please Explain:
Any Comments?
Please rate your satisfaction with the amount of time the practitioner spent with you to answer questions, explain procedures and treatment options.*
(Required)
Very Satisfied
Satisfied
Neutral
Displeased
Very Displeased
N/A
Please Explain:
Please rate your satisfaction with the practitioner recommendations.*
(Required)
Very Satisfied
Satisfied
Neutral
Displeased
Very Displeased
N/A
Please Explain:
If a procedure was recommended, please rate your satisfaction with the manner in which the practitioner discussed details and information regarding the need for the recommended procedure(s).*
(Required)
Very Satisfied
Satisfied
Neutral
Displeased
Very Displeased
N/A
Please Explain:
Do you feel you were given adequate information about:*
(Required)
Yes
No
N/A
The Overall Procedure
The Practitioner Experience
Total Fees
Possible Side Effects
Procedure Results
Post-Procedure Care
Overall Office Experience
Were you satisfied with your overall experience at our office?*
(Required)
Very Satisfied
Satisfied
Neutral
Displeased
Very Displeased
N/A
Please Explain:
Do you have any comments regarding specific staff interactions and/or ideas to improve our service?
How likely is it that you would recommend the Skin Care Center of Cool Springs Plastic Surgery to a friend or colleague?*
(Required)
10 - Extremely likely
9
8
7
6
5
4
3
2
1
0 - Not at all likely
N/A
Please Explain:
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